Provider Demographics
NPI:1497885834
Name:KENDALL PEDIATRICS
Entity Type:Organization
Organization Name:KENDALL PEDIATRICS
Other - Org Name:GUILLERMO J LLOSA, MD, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:JUAN
Authorized Official - Last Name:LLOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-274-2255
Mailing Address - Street 1:11400 N KENDALL DR
Mailing Address - Street 2:SUITE A211
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1029
Mailing Address - Country:US
Mailing Address - Phone:305-274-2255
Mailing Address - Fax:305-274-2211
Practice Address - Street 1:11400 N KENDALL DR
Practice Address - Street 2:SUITE A211
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1029
Practice Address - Country:US
Practice Address - Phone:305-274-2255
Practice Address - Fax:305-274-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 388852080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275521100Medicaid
FL275116000Medicaid
FL1063475887OtherNPI ALINA SIBLESZ RUIZ MD
FL1720077308OtherNPI GUILLERMO LLOSA, MD
FL266165900Medicaid
FLD63785Medicare UPIN